スペックルトラッキング法による慢性心不全患者免疫吸着療法治療効果の評価

2011 Fiscal Year Annual Research Report

• Project/Area Number: 22590774
• Research Institution: Shinshu University
• Principal Investigator: 小山 潤 信州大学, 医学系研究科, 准教授 (10303463)
• Co-Investigator(Kenkyū-buntansha): 池田 宇一 信州大学, 医学系研究科, 教授 (30221063)
• Keywords: 心不全 / 免疫吸着法 / 超音波

Research Abstract

昨年度に引き続き、慢性心不全患者で免疫吸着療法の適応がある患者のスクリーニング検査を入院患者の中から候補者を選択し、インフォームドコンセントがえられた患者に対し免疫吸着療法を施行した。対象患者は、心不全治療(薬剤に関してはACE阻害薬、あるいはARB,β遮断薬など)を行ったが、治療抵抗性で心不全症状が改善しない患者とした。免疫吸着療法を3から5クール施行した患者を経時的に心エコーを用いて心機能の評価を行った。免疫吸着療法前、施行後1、2、3、4、5、6、9、12ヶ月の時点でそれぞれ心エコー評価を行った。経時的変化を比較検討できるように、治療施行前の画像を心エコー装置(GE社製VIVID7)のハードドライブに記録し、その後の追跡検査時に同じ条件で画像を得ることができるように細心の注意を払った。特に画像設定の深度、フレームレート、カラードプラの設定、血流測定の関心領域の深さの設定は、各検査間で同一となるよう注意を払った。傍胸骨左縁長軸像、短軸像、心尖部像(4、2腔像、長軸像)をスペックルトラッキングによる解析が可能なフォーマットで記録し、後に必要となる解析(GE社製Echo PAC PC)が可能となるようにMOディスクに記録した。また、血流ドプラ記録(僧帽弁血流、肺静脈血流、左室流出路血流)、組織ドプラ(心尖部4腔像における心室中隔基部、側壁基部)も同時に行った。心エコー検査と平行して、血中BNP濃度などの測定を行った。また、吸着療法前後で血液中のIgGの量を定量評価した。

Current Status of Research Progress

3: Progress in research has been slightly delayed.

Reason

症例数が想定した数より少なめである。エントリー患者の追跡検査は順調である。

Strategy for Future Research Activity

本研究にエントリー可能な患者があれば症例に加える。スペックルトラッキングを用いた心機能の経時変化の解析を進める。

Research Products

• [Journal Article] Diagnostic value of abdominal wall fat pad biopsy in senile systemic amyloidosis (2011)
  • Author(s): Ikeda S, Sekijima Y, Tojo K, Koyama J
  • Journal Title: Amyloid Volume: 18 Pages: 211-215
  • Peer Reviewed
• [Journal Article] Critical role of Th17 cells in inflammation and neovascularization after ischaemia (2011)
  • Author(s): Hata T, Takahashi M, Hida S, Kawaguchi M, Kashima Y, Usui F, Morimoto H, Nishiyama A, Izawa A, Koyama J, Iwakura Y, Taki S, Ikeda U
  • Journal Title: Cardiovasc Res Volume: 90 Pages: 364-372
  • Peer Reviewed
• [Journal Article] Inflammasome activation of cardiac fibroblasts is essential for myocardial ischemia/reperfusion injury (2011)
  • Author(s): Kawaguchi M, Takahashi M, Hata T, Kashima Y; Usui F, Morimoto H, Izawa A, Takahashi Y, Matsumoto J, Koyama J, Hongo M, Noda T, Nakayama J, Sagara J, Taniguchi S, Ikeda U
  • Journal Title: Circulation Volume: 123 Pages: 594-604
  • Peer Reviewed
• [Journal Article] Early intervention with rosuvastatin decreases the lipid components of the plaque in acute coronary syndrome- analysis using integrated backscatter IVUS (ELAN Study)- (2011)
  • Author(s): Otagiri K, Tsutsui H, Kumazaki S, Miyashita Y, Aizawa K, Koshikawa M, Kasai H, Izawa A, Tomita T, Koyama J, Ikeda U
  • Journal Title: Circ J Volume: 75 Pages: 633-641
  • DOI: 10.1253/cirj.CJ-10-06000
  • Peer Reviewed
• [Journal Article] Transient pseudorestrictive pattern of transmitral flow velocity curve in patients with paroxysmal atrial fibrillation (2011)
  • Author(s): Motoki H, Koyama J, Tomita T, Aizawa K, Kasai H, Koshikawa M, Izawa A, Kumazaki S, Takahashi M, Ikeda U
  • Journal Title: Echocardiography Volume: 28 Pages: 289-297
  • DOI: 10.1111/j.1540-8175.2011.01416.x
  • Peer Reviewed
• [Presentation] Global left ventricular longitudinal strain is more sensitive than circumferential strain or torsion for detecting myocardial dysfunction in cardiac amyloidosis (2012)
  • Author(s): Koyama J, Minamisawa A, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: The 76^<th> annual scientific meeting of the Japanese circulation society(第76回日本循環器学会)
  • Place of Presentation: 福岡
  • Year and Date: 20120316-20120318
• [Presentation] Plasma BNP levels are strongly associated with global longitudinal left ventricular function in patients with cardiac amyloidosis (2012)
  • Author(s): Koyama J. Minamisawa A, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: The 76^<th> annual scientific meeting of the Japanese circulation society(第76回日本循環器学会)
  • Place of Presentation: 福岡
  • Year and Date: 20120316-20120318
• [Presentation] Wall distensibility assessed by diastolic wall strain is associated with wall thickness in patients with amyloid heart disease (2012)
  • Author(s): Minamisawa A, Koyama J, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: The 76^<th> annual scientific meeting of the Japanese circulation society(第76回日本循環器学会)
  • Place of Presentation: 福岡
  • Year and Date: 20120316-20120318
• [Presentation] Prognostic significance of pulmonary venous flow pattern and its relationship with left ventricular global longitudinal strain in light-chain amyloidosis (2011)
  • Author(s): Jun Koyama, Uichi Ikeda, Rodney H Falk
  • Organizer: The 75^<th> annual scientific meeting of the Japanese circulation society.(第75回日本循環器学会)
  • Place of Presentation: 横浜
  • Year and Date: 20110803-20110804
• [Presentation] Decreased wall distensibility assessed by diastolic epicardial movement is associated with elevated plasma BNP level in patients with cardiac amyloidosis (2011)
  • Author(s): Minamisawa A, Koyama J, Motoki H, Aizawa K, Koshikawa M, Kasa Hi, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: The 75^<th> annual scientific meeting of the Japanese circulation society.(第75回日本循環器学会)
  • Place of Presentation: 横浜
  • Year and Date: 20110803-20110804
• [Presentation] Assessment of wall distensibility from M-mode and its correlation with ultrasound tissue characterization in patients with cardiac amyloidosis (2011)
  • Author(s): Minamisawa A, Koyama J, Motoki H, Aizawa K, Koshikawa M, Kasai H, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: The 75^<th> annual scientific meeting of the Japanese circulation society.(第75回日本循環器学会)
  • Place of Presentation: 横浜
  • Year and Date: 20110803-20110804
• [Presentation] Longitudinal left ventricular strain is more sensitive than mid-wall shortening for detecting myocardial systolic dysfunction in patients with light-chain amyloidosis (2011)
  • Author(s): Koyama J, Minamisawa A, Motoki H, Aizawa K, Koshikawa M, Kasai H, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: ACC2011
  • Place of Presentation: New Orleans (USA)
  • Year and Date: 20110402-20110405
• [Presentation] Global left ventricular longitudinal, circumferential strain, and torsion assessed by speckle tracking echocardiography in patients with transthyretin associated (ATTR) cardiac amyloidosis (2011)
  • Author(s): Koyama J, Minamisawa A, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: AHA scientific sessions 2011 in Orlando
  • Place of Presentation: Orland (USA)
  • Year and Date: 2011-11-12
• [Presentation] Global longitudinal left ventricular strain assessed by speckle tracking imaging is an independent strongest predictor of plasma BNP levels in patients with cardiac amyloidosis (2011)
  • Author(s): Koyama J, Minamisawa A, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Ikeda U
  • Organizer: AHA scientific sessions 2011 in Orlando
  • Place of Presentation: Orland (USA)
  • Year and Date: 2011-11-12
• [Book] 心エコー(心アミロイドーシスどのような心エコー所見に注目すれば良いか) (2012)
  • Author(s): 小山潤
  • Total Pages: 392-399
  • Publisher: 文光堂
• [Book] 心臓腫瘍学過誤腫 (2011)
  • Author(s): 小山潤
  • Total Pages: 173-178
  • Publisher: 南山堂